interface/billing/payment_master.inc.php

   1 <?php
   2 // +-----------------------------------------------------------------------------+
   3 // Copyright (C) 2010 Z&H Consultancy Services Private Limited <sam@zhservices.com>
   4 //
   5 //
   6 // This program is free software; you can redistribute it and/or
   7 // modify it under the terms of the GNU General Public License
   8 // as published by the Free Software Foundation; either version 2
   9 // of the License, or (at your option) any later version.
  10 //
  11 //
  12 // This program is distributed in the hope that it will be useful,
  13 // but WITHOUT ANY WARRANTY; without even the implied warranty of
  14 // MERCHANTABILITY or FITNESS FOR A PARTICULAR PURPOSE.  See the
  15 // GNU General Public License for more details.
  16 //
  17 //
  18 // A copy of the GNU General Public License is included along with this program:
  19 // openemr/interface/login/GnuGPL.html
  20 // For more information write to the Free Software
  21 // Foundation, Inc., 59 Temple Place - Suite 330, Boston, MA  02111-1307, USA.
  22 //
  23 // Author:   Eldho Chacko <eldho@zhservices.com>
  24 //           Paul Simon K <paul@zhservices.com>
  25 //
  26 // +------------------------------------------------------------------------------+
  27 //===============================================================================
  28 //Check/cash details are entered here.Used in New Payment and Edit Payment screen.
  29 //===============================================================================
  30 //Special list function
  31 function generate_list_payment_category($tag_name, $list_id, $currvalue, $title,
  32   $empty_name=' ', $class='', $onchange='',$PaymentType='insurance',$screen='new_payment')
  33 {
  34   $s = '';
  35   $tag_name_esc = htmlspecialchars( $tag_name, ENT_QUOTES);
  36   $s .= "<select name='$tag_name_esc' id='$tag_name_esc'";
  37   if ($class) $s .= " class='$class'";
  38   if ($onchange) $s .= " onchange='$onchange'";
  39   $selectTitle = htmlspecialchars( $title, ENT_QUOTES);
  40   $s .= " title='$selectTitle'>";
  41   $selectEmptyName = htmlspecialchars( xl($empty_name), ENT_QUOTES);
  42   if ($empty_name) $s .= "<option value=''>" . $selectEmptyName . "</option>";
  43   $lres = sqlStatement("SELECT * FROM list_options " .
  44     "WHERE list_id = ? ORDER BY seq, title", array($list_id) );
  45   $got_selected = FALSE;
  46   while ($lrow = sqlFetchArray($lres)) {
  47     $optionValue = htmlspecialchars( $lrow['option_id'], ENT_QUOTES);
  48     $s .= "<option   id='option_" . $lrow['option_id'] . "'" . " value='$optionValue'";
  49     if ((strlen($currvalue) == 0 && $lrow['is_default']) ||
  50         (strlen($currvalue)  > 0 && $lrow['option_id'] == $currvalue)  ||
  51                 ($lrow['option_id'] == 'insurance_payment' &&  $screen=='new_payment'))
  52     {
  53       $s .= " selected";
  54       $got_selected = TRUE;
  55     }
  56   if (($PaymentType == 'insurance' || $screen=='new_payment') && ($lrow['option_id'] == 'family_payment' || $lrow['option_id'] == 'patient_payment'))
  57         $s .=  " style='background-color:#DEDEDE' ";
  58   if ($PaymentType == 'patient' && $lrow['option_id'] == 'insurance_payment')
  59         $s .=  " style='background-color:#DEDEDE' ";
  60     $optionLabel = htmlspecialchars( xl_list_label($lrow['title']), ENT_QUOTES);
  61     $s .= ">$optionLabel</option>\n";
  62   }
  63   if (!$got_selected && strlen($currvalue) > 0) {
  64     $currescaped = htmlspecialchars($currvalue, ENT_QUOTES);
  65     $s .= "<option value='$currescaped' selected>* $currescaped *</option>";
  66     $s .= "</select>";
  67     $fontTitle = htmlspecialchars( xl('Please choose a valid selection from the list.'), ENT_QUOTES);
  68     $fontText = htmlspecialchars( xl('Fix this'), ENT_QUOTES);
  69     $s .= " <font color='red' title='$fontTitle'>$fontText!</font>";
  70   }
  71   else {
  72     $s .= "</select>";
  73   }
  74   return $s;
  75 }
  76 //================================================================================================
  77 if($payment_id>0)
  78  {
  79         $rs= sqlStatement("select pay_total,global_amount from ar_session where session_id='$payment_id'");
  80         $row=sqlFetchArray($rs);
  81         $pay_total=$row['pay_total'];
  82         $global_amount=$row['global_amount'];
  83         $rs= sqlStatement("select sum(pay_amount) sum_pay_amount from ar_activity where session_id='$payment_id'");
  84         $row=sqlFetchArray($rs);
  85         $pay_amount=$row['sum_pay_amount'];
  86         $UndistributedAmount=$pay_total-$pay_amount-$global_amount;
  87
  88         $res = sqlStatement("SELECT check_date ,reference ,insurance_companies.name,
  89         payer_id,pay_total,payment_type,post_to_date,patient_id ,
  90         adjustment_code,description,deposit_date,payment_method
  91          FROM ar_session left join insurance_companies on ar_session.payer_id=insurance_companies.id    where ar_session.session_id ='$payment_id'");
  92         $row = sqlFetchArray($res);
  93         $InsuranceCompanyName=$row['name'];
  94         $InsuranceCompanyId=$row['payer_id'];
  95         $PatientId=$row['patient_id'];
  96         $CheckNumber=$row['reference'];
  97         $CheckDate=$row['check_date']=='0000-00-00'?'':$row['check_date'];
  98         $PayTotal=$row['pay_total'];
  99         $PostToDate=$row['post_to_date']=='0000-00-00'?'':$row['post_to_date'];
 100         $PaymentMethod=$row['payment_method'];
 101         $PaymentType=$row['payment_type'];
 102         $AdjustmentCode=$row['adjustment_code'];
 103         $DepositDate=$row['deposit_date']=='0000-00-00'?'':$row['deposit_date'];
 104         $Description=$row['description'];
 105         if($row['payment_type']=='insurance' || $row['payer_id']*1 > 0)
 106          {
 107                 $res = sqlStatement("SELECT insurance_companies.name FROM insurance_companies
 108                                 where insurance_companies.id ='$InsuranceCompanyId'");
 109                 $row = sqlFetchArray($res);
 110                 $div_after_save=$row['name'];
 111                 $TypeCode=$InsuranceCompanyId;
 112                  if($PaymentType=='')
 113                   {
 114                         $PaymentType='insurance';
 115                   }
 116          }
 117         elseif($row['payment_type']=='patient' || $row['patient_id']*1 > 0)
 118          {
 119                 $res = sqlStatement("SELECT fname,lname,mname FROM patient_data
 120                                 where pid ='$PatientId'");
 121                 $row = sqlFetchArray($res);
 122                         $fname=$row['fname'];
 123                         $lname=$row['lname'];
 124                         $mname=$row['mname'];
 125                         $div_after_save=$lname.' '.$fname.' '.$mname;
 126                 $TypeCode=$PatientId;
 127                  if($PaymentType=='')
 128                   {
 129                         $PaymentType='patient';
 130                   }
 131          }
 132  }
 133 ?>
 134 <?php
 135 //================================================================================================
 136 if(($screen=='new_payment' && $payment_id*1==0) || ($screen=='edit_payment' && $payment_id*1>0))
 137  {//New entry or edit in edit screen comes here.
 138 ?>
 139 <table width="1024" border="0" cellspacing="0" cellpadding="10" bgcolor="#DEDEDE"><tr><td>
 140         <table width="1004" border="0" style="border:1px solid black" cellspacing="0" cellpadding="0">
 141           <tr height="5">
 142                 <td colspan="14" align="left" ></td>
 143           </tr>
 144           <tr>
 145                 <td colspan="14" align="left">&nbsp;<font class='title'>
 146                 <?php
 147                   if($_REQUEST['ParentPage']=='new_payment')//This case comes when the Finish Payments is pressed from the New Payment screen.
 148                   {
 149                   ?>
 150                         <?php echo htmlspecialchars( xl('Confirm Payment'), ENT_QUOTES) ?>
 151                 <?php
 152                   }
 153                  elseif($screen=='new_payment')
 154                   {
 155                   ?>
 156                         <?php echo htmlspecialchars( xl('Batch Payment Entry'), ENT_QUOTES) ?>
 157                 <?php
 158                   }
 159                  else
 160                   {
 161                   ?>
 162                         <?php echo htmlspecialchars( xl('Edit Payment'), ENT_QUOTES) ?>
 163                 <?php
 164                   }
 165                   ?>
 166                 </font></td>
 167           </tr>
 168           <tr height="20">
 169             <td align="left" width="5" ></td>
 170                 <td align="left" width="110" ></td>
 171                 <td align="left" width="128"></td>
 172                 <td align="left" width="25"></td>
 173                 <td align="left" width="5"></td>
 174             <td align="left" width="85"></td>
 175             <td align="left" width="128"></td>
 176             <td align="left" width="25"></td>
 177             <td align="left" width="5"></td>
 178             <td align="left" width="113"></td>
 179             <td align="left" width="125"></td>
 180             <td align="left" width="5"></td>
 181             <td align="left" width="93"></td>
 182             <td align="left" width="152"></td>
 183             </tr>
 184           <tr>
 185             <td align="left" class='text'></td>
 186                 <td align="left" class='text'><?php echo htmlspecialchars( xl('Date'), ENT_QUOTES).':' ?></td>
 187                 <td align="left" class="text" ><input type='text' size='9' name='check_date' id='check_date' class="class1 text "  value="<?php echo htmlspecialchars(oeFormatShortDate($CheckDate));?>"/></td>
 188                 <td><img src='../../interface/main/calendar/modules/PostCalendar/pntemplates/default/images/new.jpg' align='absbottom'
 189                 id='img_checkdate' border='0' alt='[?]' style='cursor:pointer'
 190                 title='<?php echo htmlspecialchars( xl('Click here to choose a date'), ENT_QUOTES); ?>' />
 191            <script>
 192                 Calendar.setup({inputField:"check_date", ifFormat:"<?php echo $DateFormat; ?>", button:"img_checkdate"});
 193            </script></td>
 194                 <td></td>
 195             <td align="left" class='text'><?php echo htmlspecialchars( xl('Post To Date'), ENT_QUOTES).':' ?></td>
 196             <td align="left" class="text"><input type='text' size='9' name='post_to_date' id='post_to_date' class="class1 text "   value="<?php echo $screen=='new_payment'?htmlspecialchars(oeFormatShortDate(date('Y-m-d'))):htmlspecialchars(oeFormatShortDate($PostToDate));?>"  readonly="" /></td>
 197             <td><img src='../../interface/main/calendar/modules/PostCalendar/pntemplates/default/images/new.jpg' align='absbottom'
 198                 id='img_post_to_date' border='0' alt='[?]' style='cursor:pointer'
 199                 title='<?php echo htmlspecialchars( xl('Click here to choose a date'), ENT_QUOTES); ?>' />
 200            <script>
 201                 Calendar.setup({inputField:"post_to_date", ifFormat:"<?php echo $DateFormat; ?>", button:"img_post_to_date"});
 202            </script></td>
 203             <td></td>
 204             <td align="left" class="text"><?php echo htmlspecialchars( xl('Payment Method'), ENT_QUOTES).':' ?></td>
 205             <td align="left">
 206                         <?php
 207                                 if($PaymentMethod=='' && $screen=='edit_payment')
 208                                         $blankValue=' ';
 209                                 else
 210                                         $blankValue='';
 211                         echo generate_select_list("payment_method", "payment_method", "$PaymentMethod", "Payment Method","$blankValue","class1 text",'CheckVisible("yes")');
 212                         ?>
 213           </td>
 214             <td></td>
 215             <td align="left" class="text"><?php echo htmlspecialchars( xl('Check Number'), ENT_QUOTES).':' ?></td>
 216             <td>
 217                 <?php
 218                 if($PaymentMethod=='check_payment' || $PaymentMethod=='bank_draft' || $CheckNumber!='' || $screen=='new_payment')
 219                  {
 220                   $CheckDisplay='';
 221                   $CheckDivDisplay=' display:none; ';
 222                  }
 223             else
 224                  {
 225                   $CheckDisplay=' display:none; ';
 226                   $CheckDivDisplay='';
 227                  }
 228                 ?>
 229                 <input type="text" name="check_number"  style="width:140px;<?php echo $CheckDisplay;?>"  autocomplete="off"  value="<?php echo htmlspecialchars($CheckNumber);?>"  onKeyUp="ConvertToUpperCase(this)"  id="check_number"  class="text "   />
 230                 <div  id="div_check_number" class="text"  style="border:1px solid black; width:140px;<?php echo $CheckDivDisplay;?>">&nbsp;</div>
 231            </td>
 232            </tr>
 233           <tr height="1">
 234                 <td colspan="14" align="left" ></td>
 235           </tr>
 236           <tr>
 237             <td align="left" class="text"></td>
 238                 <td align="left" class="text"><?php echo htmlspecialchars( xl('Payment Amount'), ENT_QUOTES).':' ?></td>
 239                 <td align="left"><input   type="text" name="payment_amount"   autocomplete="off"  id="payment_amount"  onchange="ValidateNumeric(this);<?php echo $screen=='new_payment'?'FillUnappliedAmount();':'FillAmount();';?>"  value="<?php echo $screen=='new_payment'?htmlspecialchars('0.00'):htmlspecialchars($PayTotal);?>"  style="text-align:right"    class="class1 text "   /></td>
 240             <td align="left" ></td>
 241             <td align="left" ></td>
 242                 <td align="left" class="text"><?php echo htmlspecialchars( xl('Paying Entity'), ENT_QUOTES).':' ?></td>
 243                 <td align="left"><?php
 244                                 if($PaymentType=='' && $screen=='edit_payment')
 245                                         $blankValue=' ';
 246                                 else
 247                                         $blankValue='';
 248                         echo generate_select_list("type_name", "payment_type", "$PaymentType", "Paying Entity","$blankValue","class1 text",'PayingEntityAction()');
 249                         ?>
 250                 </td>
 251             <td align="left" ></td>
 252             <td align="left" ></td>
 253                 <td align="left" class="text"><?php echo htmlspecialchars( xl('Payment Category'), ENT_QUOTES).':' ?></td>
 254                 <td align="left"><?php
 255                                 if($AdjustmentCode=='' && $screen=='edit_payment')
 256                                         $blankValue=' ';
 257                                 else
 258                                         $blankValue='';
 259                         echo generate_list_payment_category("adjustment_code", "payment_adjustment_code", "$AdjustmentCode",
 260                         "Payment Category","$blankValue","class1 text",'FilterSelection(this)',"$PaymentType","$screen");
 261                         ?>
 262            </td>
 263             <td align="left" ></td>
 264             <td align="left" ></td>
 265             <td align="left" ></td>
 266             </tr>
 267           <tr height="1">
 268                 <td colspan="14" align="left" ></td>
 269           </tr>
 270           <tr>
 271             <td align="left" class="text"></td>
 272                 <td align="left" class="text"><?php echo htmlspecialchars( xl('Payment From'), ENT_QUOTES).':' ?></td>
 273                 <td align="left" colspan="5"><input type="hidden" id="hidden_ajax_close_value" value="<?php echo htmlspecialchars($div_after_save);?>" /><input name='type_code'  id='type_code' class="text "  style="width:369px"   onKeyDown="PreventIt(event)"  value="<?php echo htmlspecialchars($div_after_save);?>"  autocomplete="off"   /><br>
 274                 <!-- onKeyUp="ajaxFunction(event,'non','edit_payment.php');" -->
 275                  <div id='ajax_div_insurance_section'>
 276                   <div id='ajax_div_insurance_error'>
 277                   </div>
 278                   <div id="ajax_div_insurance" style="display:none;"></div>
 279                   </div>
 280                  </div>
 281                                 </td>
 282                 <td align="left" colspan="5"><div  name="div_insurance_or_patient" id="div_insurance_or_patient" class="text"  style="border:1px solid black; padding-left:5px; width:55px; height:17px;"><?php echo htmlspecialchars($TypeCode);?></div></td>
 283             <td align="left" ></td>
 284             <td align="left" ></td>
 285             </tr>
 286           <tr>
 287             <td align="left" class='text'></td>
 288                 <td align="left" class='text'><?php echo htmlspecialchars( xl('Deposit Date'), ENT_QUOTES).':' ?></td>
 289                 <td align="left"><input type='text' size='9' name='deposit_date' id='deposit_date'  onKeyDown="PreventIt(event)"   class="class1 text " value="<?php echo htmlspecialchars(oeFormatShortDate($DepositDate));?>"    />      </td>
 290                 <td><img src='../../interface/main/calendar/modules/PostCalendar/pntemplates/default/images/new.jpg' align='absbottom'
 291                 id='img_depositdate' border='0' alt='[?]' style='cursor:pointer'
 292                 title='<?php echo htmlspecialchars( xl('Click here to choose a date'), ENT_QUOTES); ?>' />
 293            <script>
 294                 Calendar.setup({inputField:"deposit_date", ifFormat:"<?php echo $DateFormat; ?>", button:"img_depositdate"});
 295            </script></td>
 296                 <td></td>
 297             <td align="left" class="text"><?php echo htmlspecialchars( xl('Description'), ENT_QUOTES).':' ?></td>
 298             <td colspan="6" align="left"><input type="text" name="description"  id="description"   onKeyDown="PreventIt(event)"   value="<?php echo htmlspecialchars($Description);?>"   style="width:396px" class="text "   /></td>
 299             <td align="left" class="text"><font  style="font-size:11px"><?php echo htmlspecialchars( xl('UNDISTRIBUTED'), ENT_QUOTES).':' ?></font><input name="HidUnappliedAmount" id="HidUnappliedAmount"  value="<?php echo ($UndistributedAmount*1==0)? htmlspecialchars("0.00") : htmlspecialchars(number_format($UndistributedAmount,2,'.',','));?>" type="hidden"/><input name="HidUnpostedAmount" id="HidUnpostedAmount"  value="<?php echo htmlspecialchars($UndistributedAmount); ?>" type="hidden"/><input name="HidCurrentPostedAmount" id="HidCurrentPostedAmount"  value="" type="hidden"/></td>
 300                 <td align="left" class="text"><div  id="TdUnappliedAmount" class="text"  style="border:1px solid black; width:75px; background-color:#EC7676; padding-left:5px;"><?php echo ($UndistributedAmount*1==0)? htmlspecialchars("0.00") : htmlspecialchars(number_format($UndistributedAmount,2,'.',','));?></div></td>
 301             </tr>
 302         <?php
 303         if($screen=='new_payment')
 304          {
 305         ?>
 306           <tr>
 307                 <td colspan="14" align="center" class="text" id="TdContainingButtons">
 308                 <table border="0" cellspacing="0" cellpadding="0" width="280">
 309                   <tr height="5">
 310                         <td ></td>
 311                         <td></td>
 312                         <td></td>
 313                   </tr>
 314                   <tr>
 315                         <td width="100"><a href="#" onClick="javascript:return SavePayment();" class="css_button"><span><?php echo htmlspecialchars( xl('Save Changes'), ENT_QUOTES);?></span></a></td>
 316                     <td width="110"><a href="#" onClick="javascript:ResetForm()" class="css_button"><span><?php echo htmlspecialchars( xl('Cancel Changes'), ENT_QUOTES);?></span></a></td>
 317                     <td width="70"><a href="#" class="css_button" onClick="javascript:OpenEOBEntry();"><span><?php echo htmlspecialchars( xl('Allocate'), ENT_QUOTES);?></span></a></td>
 318                   </tr>
 319                 </table>                </td>
 320           </tr>
 321         <?php
 322          }
 323         ?>
 324           <tr height="5">
 325                 <td colspan="14" align="left" ></td>
 326           </tr>
 327         </table>
 328         </td></tr></table>
 329 <?php
 330 }//if(($screen=='new_payment' && $payment_id*1==0) || ($screen=='edit_payment' && $payment_id*1>0))
 331 //================================================================================================
 332 ?>
 333 <?php
 334 if($screen=='new_payment' && $payment_id*1>0)
 335  {//After saving from the New Payment screen,all values are  showed as labels.The date picker images are also removed.
 336 ?>
 337 <table width="1024" border="0" cellspacing="0" cellpadding="10" bgcolor="#DEDEDE"><tr><td align="left">
 338         <table width="1004" border="0" style="border:1px solid black" cellspacing="0" cellpadding="0">
 339           <tr height="5">
 340                 <td colspan="13" align="left" ></td>
 341           </tr>
 342           <tr>
 343                 <td colspan="13" align="left" >
 344
 345                         <table width="969" border="0"  cellspacing="0" cellpadding="0" align="left">
 346                                   <tr>
 347                                         <td colspan="13" align="left">&nbsp;<font class='title'><?php echo htmlspecialchars( xl('Batch Payment Entry'), ENT_QUOTES) ?></font></td>
 348                                   </tr>
 349                                   <tr height="20">
 350                                         <td align="left" width="5" ></td>
 351                                         <td align="left" width="106" ></td>
 352                                         <td align="left" width="128"></td>
 353                                         <td align="left" width="5"></td>
 354                                         <td align="left" width="84"></td>
 355                                         <td align="left" width="128"></td>
 356                                         <td align="left" width="5"></td>
 357                                         <td align="left" width="113"></td>
 358                                         <td align="left" width="135"></td>
 359                                         <td align="left" width="5"></td>
 360                                         <td align="left" width="92"></td>
 361                                         <td align="left" width="158"></td>
 362                                         <td align="left" width="5"></td>
 363                                   </tr>
 364                                   <tr>
 365                                         <td align="left" class='text'></td>
 366                                         <td align="left" class='text'><?php echo htmlspecialchars( xl('Date'), ENT_QUOTES).':' ?></td>
 367                                         <td align="left" class="text bottom left top right">&nbsp;<?php echo htmlspecialchars(oeFormatShortDate($CheckDate));?><input type="hidden" name="check_date" value="<?php echo htmlspecialchars(oeFormatShortDate($CheckDate));?>"/></td>
 368                                         <td></td>
 369                                         <td align="left" class='text'><?php echo htmlspecialchars( xl('Post To Date'), ENT_QUOTES).':' ?></td>
 370                                         <td align="left" class="text bottom left top right">&nbsp;<?php echo htmlspecialchars(oeFormatShortDate($PostToDate));?><input type="hidden" name="post_to_date" value="<?php echo htmlspecialchars(oeFormatShortDate($PostToDate));?>"/></td>
 371                                         <td></td>
 372                                         <td align="left" class="text"><?php echo htmlspecialchars( xl('Payment Method'), ENT_QUOTES).':' ?></td>
 373                                         <td align="left" class="text bottom left top right">&nbsp;<?php
 374                                                                 $frow['data_type']=1;
 375                                                                 $frow['list_id']='payment_method';
 376                                                                 generate_print_field($frow, $PaymentMethod);
 377                                   ?><input type="hidden" name="payment_method" value="<?php echo htmlspecialchars($PaymentMethod);?>"/></td>
 378                                         <td></td>
 379                                         <td align="left" class="text"><?php echo htmlspecialchars( xl('Check Number'), ENT_QUOTES).':' ?></td>
 380                                         <td class="text bottom left top right">&nbsp;<?php echo htmlspecialchars($CheckNumber);?><input type="hidden" name="check_number" value="<?php echo htmlspecialchars($CheckNumber);?>"/></td>
 381                                         <td class="text"></td>
 382                                   </tr>
 383                                   <tr height="1">
 384                                         <td colspan="13" align="left" ></td>
 385                                   </tr>
 386                                   <tr>
 387                                         <td align="left" class="text"></td>
 388                                         <td align="left" class="text"><?php echo htmlspecialchars( xl('Payment Amount'), ENT_QUOTES).':' ?></td>
 389                                         <td align="left" class="text bottom left top right">&nbsp;<?php echo htmlspecialchars($PayTotal);?><input type="hidden" name="payment_amount" value="<?php echo htmlspecialchars($PayTotal);?>"/></td>
 390                                         <td align="left" ></td>
 391                                         <td align="left" class="text"><?php echo htmlspecialchars( xl('Paying Entity'), ENT_QUOTES).':' ?></td>
 392                                         <td align="left" class="text bottom left top right">&nbsp;<?php
 393                                                                 $frow['data_type']=1;
 394                                                                 $frow['list_id']='payment_type';
 395                                                                 generate_print_field($frow, $PaymentType);
 396                                   ?><input type="hidden" name="type_name" id="type_name" value="<?php echo htmlspecialchars($PaymentType);?>"/></td>
 397                                         <td align="left" ></td>
 398                                         <td align="left" class="text"><?php echo htmlspecialchars( xl('Payment Category'), ENT_QUOTES).':' ?></td>
 399                                         <td align="left" class="text bottom left top right">&nbsp;<?php
 400                                                                 $frow['data_type']=1;
 401                                                                 $frow['list_id']='payment_adjustment_code';
 402                                                                 generate_print_field($frow, $AdjustmentCode);
 403                                   ?><input type="hidden" name="adjustment_code" value="<?php echo htmlspecialchars($AdjustmentCode);?>"/></td>
 404                                         <td align="left" ></td>
 405                                         <td align="left" ></td>
 406                                         <td align="left" ></td>
 407                                         <td align="left" ></td>
 408                                   </tr>
 409                                   <tr height="1">
 410                                         <td colspan="13" align="left" ></td>
 411                                   </tr>
 412                                   <tr>
 413                                         <td align="left" class="text"></td>
 414                                         <td align="left" class="text"><?php echo htmlspecialchars( xl('Payment From'), ENT_QUOTES).':' ?></td>
 415                                         <td colspan="4" align="left" class="text bottom left top right"><div  name="div_insurance_or_patient" id="div_insurance_or_patient" class="text"  >&nbsp;<?php echo htmlspecialchars($div_after_save);?>&nbsp;</div></td>
 416                                         <td align="left"></td>
 417                                         <td align="left" ><div  name="div_insurance_or_patient" id="div_insurance_or_patient" class="text"  style="border:1px solid black; padding-left:5px; width:55px"><?php echo htmlspecialchars($TypeCode);?></div><input type="hidden" name="type_code" value="<?php echo htmlspecialchars($TypeCode);?>"/></td>
 418                                         <td align="left" ></td>
 419                                         <td align="left" ></td>
 420                                         <td align="left" ></td>
 421                                         <td align="left" ></td>
 422                                         <td align="left" ></td>
 423                                   </tr>
 424                                   <tr height="1">
 425                                         <td colspan="13" align="left" ></td>
 426                                   </tr>
 427                                   <tr>
 428                                         <td align="left" class='text'></td>
 429                                         <td align="left" class='text'><?php echo htmlspecialchars( xl('Deposit Date'), ENT_QUOTES).':' ?></td>
 430                                         <td align="left" class="text bottom left top right">&nbsp;<?php echo htmlspecialchars(oeFormatShortDate($DepositDate));?><input type="hidden" name="deposit_date" value="<?php echo htmlspecialchars(oeFormatShortDate($DepositDate));?>"/>        </td>
 431                                         <td></td>
 432                                         <td align="left" class="text"><?php echo htmlspecialchars( xl('Description'), ENT_QUOTES).':' ?></td>
 433                                         <td colspan="4" align="left" class="text bottom left top right">&nbsp;<?php echo htmlspecialchars($Description);?><input type="hidden" name="description" value="<?php echo htmlspecialchars($Description);?>"/></td>
 434                                         <td align="left" class='text'></td>
 435                                         <td align="left" class="text"><font  style="font-size:11px"><?php echo htmlspecialchars( xl('UNDISTRIBUTED'), ENT_QUOTES).':' ?></font><input name="HidUnappliedAmount" id="HidUnappliedAmount"  value="<?php echo ($UndistributedAmount*1==0)? htmlspecialchars("0.00") : htmlspecialchars(number_format($UndistributedAmount,2,'.',','));?>" type="hidden"/><input name="HidUnpostedAmount" id="HidUnpostedAmount"  value="<?php echo htmlspecialchars($UndistributedAmount); ?>" type="hidden"/>
 436  <input name="HidCurrentPostedAmount"  id="HidCurrentPostedAmount"  value="" type="hidden"/></td>
 437                                         <td align="left" ><div  id="TdUnappliedAmount" class="text"  style="border:1px solid black; background-color:#EC7676; width:75px; padding-left:5px;"><?php echo ($UndistributedAmount*1==0)? htmlspecialchars("0.00") : htmlspecialchars(number_format($UndistributedAmount,2,'.',','));?></div></td>
 438                                         <td align="left" class="text"></td>
 439                                   </tr>
 440                                   <tr height="5">
 441                                         <td colspan="13" align="left"></td>
 442                                   </tr>
 443                         </table>
 444                 </td>
 445           </tr>
 446         </table>
 447         </td></tr></table>
 448 <?php
 449 }//if($screen=='new_payment' && $payment_id*1>0)
 450 //================================================================================================
 451 ?>